00:02
First off, I think we'll talk about
squamous cell carcinoma
before coming back to
basal cell carcinoma.
00:08
Squamous cell carcinoma,
as you may recall
typically is on a spectrum
of development or evolution
starting with actinic keratosis,
then squamous cell carcinoma in situ
and then squamous
cell carcinoma.
00:21
Actinic keratosis are described
as these discrete
dry, sandpapery, skin colored
or yellow-brown papules.
00:31
They're incredibly common,
very hard to see just visually
until you reach in closely,
look closely at the skin
and rub your fingers
on the lesion
and you'll feel
that sandpapery lesion
especially on the scalp of folks
who are balding or bald
or on the backs
of the hands.
00:49
One percent
of actinic keratosis
will evolve into squamous cell
carcinoma in situ per year.
00:57
So, if you got 50 of them,
there's a 50% chance
that one of those
might evolve into
squamous cell carcinoma
in situ each year.
01:05
When you've got squamous
cell carcinoma in situ
especially a background
of several of them
these well-demarcated pink,
scaly patches
it's called Bowen’s disease
and a minority of these squamous cell carcinoma in situ lesions
can evolve into
squamous cell carcinoma itself
which, of course, is more malignant
and can be aggressive.
01:26
So, a number of different subtypes
of squamous cell carcinoma
we'll talk about them
in a minute
and these can be eroded, friable,
hyperkeratotic papules
or plaques or nodules.
01:38
So, a lot of different varieties of
squamous cell carcinoma to be mindful of.
01:44
The risk factors for
squamous cell carcinoma
and actinic keratosis
are things we've talked about:
fair complexion, folks who have
chronic wounds in a certain area
squamous cell carcinoma in situ
may develop
within those chronic wounds
chronic sun exposure
like being a farmer
HPV, again keeps showing up
in different places
as a cause of different
types of skin lesions
including squamous cell carcinoma
and smoking history
also plays a role.
02:12
So, here's the subtypes.
02:14
We have the nodular type
shown here in the top right.
02:18
Exophytic type which is more
representative of the picture
down there at the bottom.
02:23
Again, exophytic means
growing out of the skin.
02:26
Verrucous which is
not shown here
and then a cutaneous horn
which is this hyperkeratinized plug
that can grow out of a lesion
and it's very firm, very hard.
02:41
As we discussed with melanoma,
if a patient starts to describe
pain or paresthesias like pruritus
within their lesion
that may signify
deeper invasion
into the dermis
and perineural invasions
that may be a bad
prognostic sign.
02:55
You're going to diagnose
this by performing
a shave biopsy
or perhaps a punch biopsy.
03:00
The treatment
is going to depend on
if you've got
actinic keratosis
or if you actually
have skin cancer.
03:06
Actinic keratosis and
squamous cell carcinoma in situ
you can get by
with just cryosurgery
just basically
freezing the lesion.
03:13
You can use 5-FU cream
or imiquimod cream
and just close
observation over time.
03:19
Once you've developed into
a squamous cell carcinoma
you're going to need
to perform an excision
and you may or may not need
to use Mohs surgery
depending upon the type
of lesion that you have.
03:30
Now, let's talk about
basal cell carcinoma
the other type of
non melanoma skin cancer
and it also happens to be the most
common type of skin cancer.
03:39
You really have to make sure
you know this one.
03:41
It's locally invasive
and aggressive.
03:44
However,
it's actually relatively benign
insofar as
it rarely metastasizes.
03:49
So, you may find patients
who have basal cell carcinoma
but it's not an emergency.
03:54
You certainly want to get it
dealt with and get it resected.
03:56
But it's not something where
you're very concerned
about long term outcomes
as you would for melanoma.
04:02
Ninety percent of the time,
they occur on the face.
04:05
Our patient’s got it on his nose,
so let's keep that in mind.
04:10
Multiple different subtypes again,
and you’d have to just be familiar
with the names here when you're
thinking about the board exam
but the subtypes are the
superficial multicentric
which is shown here
in the top picture.
04:22
Pigmented, again, these can be
very black, brown, dark reddish lesions
as you're seeing here
in number two.
04:30
Ulcerating lesion which can
have rolled borders
and a central hollowing out
ulcerated area.
04:37
Not shown here is
the sclerosing subtype.
04:40
Then the nodular subtype,
we'll see on the next slide.
04:44
Here's our nodular subtype,
which again, is you're going to feel
a palpable subdermal
indurated area
it's going to have some
telangiectesias on the skin
and there may be an ulcerated area
in the middle as well.
04:57
The nodular and ulcerating subtypes
are pretty similar to one another.
05:02
Going back to look at our patient,
there's no evidence of pruritus
and that's pretty typical
for basal cell carcinoma lesions.
05:10
This patient spends most of his day
in sun-exposed areas.
05:14
So, we're thinking about
any kind of skin cancer
and basal cell carcinoma would be
one of the more common types.
05:19
Again, a dome-shaped,
pearly, translucent papule
on the tip of the nose,
on the face, as we mentioned
with visible telangiectesias
and probably some
somewhat rolled-up borders.
05:31
This is really
a very good example
of a nodular type of
basal cell carcinoma.
05:36
With all that
information in mind
I think we can
safely say
that our patient has
a basal cell carcinoma
presumably
the nodular subtype.
05:45
Let's just review a few key points
about basal cell carcinoma.
05:49
As I said, it's the
most common skin cancer.
05:51
It's locally invasive and aggressive
but rarely metastasizes
and 90% of the time,
it is on the face.
05:57
Treatment is going
to be excision.
06:00
You don't typically need
to use Mohs surgery
because again,
it's not a very aggressive lesion
in terms of distant metastasis
or recurrence.
06:08
You can use electrodessication
and curettage as well.
06:11
Shown there on
the right
is a reminder of
our five different subtypes.